W4 - Maxillofacial Injuries - Thomson Flashcards
What is carried out in the initial assessment of maxfax injuries (6)
- Rapid survey of vital functions & priotize managment options
- ABCDE
- Any head injury?
- Prevent infection
- Pain management
- Temporary immobilisation / fixation
What is the first thing to consider when managing head injuries
Prevention of secondary brain injury due to lack of cerebral circulation
ABC
Airway
Breathing (may have had chest injuries)
Circulation (control any haemorrhage)
What is required for proper diagnosis of maxfax injuries (5)
History
Exam
Diagnostic Features
Imaging
Study models
what are some facial soft tissue structures that can be affected by maxillofacial injuries (4)
Innervations (facial nerve / infraorbital nerve)
Parotid duct
Parotid gland
Nasolacrimal duct
How to manage hard tissue injuries / bone injuries (maxfax) (4)
Reduction (reduce the fracture zone aka put bone together)
Fixation
Immobilization
Rehabilitation
What to do with nasal fractures (immediately)
Push nasal bones back to original position straight away
- Put thumb up nose and shift nose back to original position
- Put splint afterwards
What indirect fracture can occur with injury to symphysis or parasymphysis (front of mandible or body)
Fractured condyle or angle
Where are the fractures
Direct fracture: Right parasyntheal fracture
Indirect fracture: Left angle of md fracture
Diagnostic features of fractured unilateral condyle (affected side 5 and opposite side 2)
Affected side
- Joint pain (worse with moving)
- Swelling & tenderness
- Deviation of md on opening
- Premature posterior contact
- Abnormal movements of condylar head
Opposite side
- Open bite
- Limited lateral excursion
Unilateral condyle fracture
Diagnostic features of bilateral condyle fracture (5)
AKA “Guardsman fracture”
- Pain, tenderness, swelling over both joints
- Premature posterior contact
- Anterior open bite
- Restricted lateral movement
- Absence of condylar head movement
Diagnostic features of body of mandible fracture (5)
Haematoma in floor of mouth / buccal sulcus
Trismus
Pain when moving jaw
Step deformity at lower border
Mental anesthesia
Derangement of occlusion
Movement & crepitus at fracture site
Body of mandible fracture
Bilateral condylar fracture
Diagnostic features of zygoma fractures
Depression of cheek prominence
Subconjunctival haemorrhage
Step deformity on infra-orbital ridge
Infra-orbital nerve anesthesia
Trismus
Blood in antrum
Zygoma fracture
- notive step deformity of infraorbital ridge
- Subconjunctival haemorrhage
- Depression of cheek prominence
zygomatic fracture
Zygomatic fracture
What is this and how is it caused
Retrobulbar haemorrhage (listen again 40 min)
Describe the 3 le forts
Features of le fort 1 fracture (4)
- Floating palate
- Blood in antrum
- Bilateral haematoma
- Deranged occlusion with anterior open bite
Features of le fort 2 frac (5)
Gross swelling then dish faced deformity
Subconjunctival haemorrage
Bilateral infra-orbital nerve anesthesia
bilateral haematoma intra-orally
Retroposed upper dental arch w/anterior open bite
Features of le fort 3 fracture
Gross swelling, then dish-faced deformity
Subconjunctival haemorrhage
CSF leak from nose
Head injury
Retroposed upper dental arch w / anterior open bite
Isolated orbital floor fracture
Complications of maxillofacial injuries (6)
Psychological trauma
Scarring
Soft tissue / bone loss
infection
Malunion
Trismus
